Dr Jaclyn Smith (UHSM) talks about chronic cough and what can be done to help sufferers

1. Support Meeting for
Aspergillosis Patients
LED BY GRAHAM ATHERTON
SUPPORTED BY
MARIE KIRWAN, GEORGINA POWELL & DEBBIE KENNEDY
NAC CENTRE MANAGER CHRIS HARRIS
COUGH: JACLYN SMITH
NATIONAL ASPERGILLOSIS CENTRE
UHSM
MANCHESTER
Fungal Research Trust

2. Programme
 1pm Introduction
 1:05 Jaclyn Smith
 2:00 Tea & Coffee
 2.10 LIFE art competition entries
 2.30 Announcement of changes to this meeting
 3:00 Close

3. Tackling Cough
Dr Jacky Smith
MRC Clinician Scientist/Reader
University of Manchester and University
Hospital South Manchester

4. Talk Plan
• What is a cough?
• Why do people cough?
• How big a problem is cough?
• A bit about my research….
• Conclusions
• Questions

5. Why am I interested in cough?
• Cough is really common
• Cough affects peoples quality of life
• Cough is difficult to treat

6. What is a Cough?
• A reflex in healthy people
• A symptom of disease
– Lung
– Nose and Sinuses
– Gullet

7. What is a Cough?
Breathe Start to
Close Open
breathe
in Voicebox voicebox
out

8. What is a Cough?

9. Why do people cough?
The Cough Reflex
rve
ne
Va
gu
s
COUGH
IRRITANT
Larynx/Airway Expiratory Muscles

10. Nerves important in Cough Human
Human
C FIBRES Aδ FIBRES
Chemically Mechanical & acid
Sensitive Sensitive
Guinea Pig Guinea Pig
Unpublished data Dr Pete West Summary from publications by Canning & Undem

11. H+
H +
C FIBRE Aδ FIBRE
TERMINALS TERMINALS

12. General Practice Visits: US 2001–
02
Schappert SM, Burt CW. Vital Health Stat 13(159). 2006

13. Over- the-Counter Sales UK
PAGB report 2010

14. Over-The-Counter Medicines Sales
Sales (millions of US dollars)

15. Classification of Cough

16. Estimated UK Incident of Acute Cough
Hospitalisations
GP Consults
Self Medication
Acute Cough
Viral Infection
ANNUAL COSTS TO UK ECONOMY OVER £979 MILLION/YEAR

17. Chronic Cough Case History
• 56 year old woman
• Dry cough for 4 years
• Had lots of treatments ‘nothing works’
• Driving husband/partner mad
• Sleep separately
• Urinary Incontinence

18. Hypersensitivity of Chronic Cough
Patients to Environmental Exposures
Young et al (unpublished data)

19. Hypersensitivity of Chronic Cough
Patients to Temperature
Young et al (unpublished data)

20. Hypersensitivity to Mechanical Stimuli
Young et al (unpublished data)

21. Chronic Cough is miserable
PHYSICAL
PSYCHOLOGICAL SOCIAL

22. Chronic Cough is miserable
Sleep disturbance Exhaustion
Syncope Chest pain
Urinary
Incontinence Vomiting
PHYSICAL
PSYCHOLOGICAL SOCIAL

23. Chronic Cough is miserable
PHYSICAL
Absenteeism
Effects on
Spouse
PSYCHOLOGICAL SOCIAL
Social
Gatherings
Medical
Treatment Consultations
expense

24. Chronic Cough is miserable
PHYSICAL
Anger
Frustration
PSYCHOLOGICAL SOCIAL
Embarrassment
Depression
Anxiety

25. Chronic Cough is miserable
Sleep disturbance Exhaustion
Syncope Chest pain
Urinary
Incontinence Vomiting
PHYSICAL
Anger Absenteeism
Effects on
Frustration Spouse
PSYCHOLOGICAL SOCIAL
Social
Embarrassment Gatherings
Depression Medical
Anxiety Treatment Consultations
expense

26. Causes of Chronic Cough
Almost all Chronic Lung Diseases Cause Cough
• Asthma
• Chronic Obstructive Pulmonary Disease
(Smoking related)
– Chronic Bronchitis
• Lung Fibrosis
• Bronchiectasis........

27. Other Causes of Chronic Cough
‘Idiopathic’

28. Gastro-oesophgeal Reflux & Cough
Laryngo- Micro-
Pharyngeal aspiration
Reflux
Oesophageal
Reflux

29. ‘Rice Ball’ Cough

30. Tracheobronchopathia
Osteochrondroplastica

31. Unexplained Chronic Cough
Haque et al Chest May 2005 vol. 127 no. 5 1710-1713

32. Typical Cough Sound

33. Measuring Cough Sounds
25
20
cough frequency cs/hr
Oesophageal Impedance/pH
15
10
5
0
baseline placebo codeine
Smith et al J Allergy Clin Immunol. 2006 Apr;117(4):831-5

34. Cough Frequency in Respiratory Diseases

35. Diurnal Variation in Chronic Cough

36. How to treat a Chronic Cough?
i. Treat any underlying conditions
ii. Low dose Morphine
iii. Speech and Language Therapy
iv. Gabapentin/Pregabalin*
v. Baclofen*
*handle with care

37. Conclusions
• Chronic Cough is a common problem
• Very significant impact for patients
• Increasing recognition of ‘unexplained cough’
cough
• Treatment options limited

38. Questions?

39. Student competitions
Aim: Building awareness amongst younger people & parents
 Art & music
 Original compositions
 £1200 prize (school & individual share)
 Theme is ‘funky fungi’
 UPDATE: 3-400 entries – will be judged over the summer
www. projectlifecompetition.org

40. Annual Survey of Patients
105 patients asked
10% had been to a Support Meeting
9% viewed online
26% viewed recordings
47% do not use Aspergillus Website
Approximately 50% do not use the internet
WE NEED TO SUPPORT THOSE PEOPLE NOT
USING INTERNET BETTER

41. Annual Survey of Patients
Why don’t you attend the Aspergillosis Support Meeting?

42. Time and Place
Most attend clinic on Friday
Closer to Clinic the better
Meeting now to be held in Friday afternoons at 1.30pm
Hope to move the meeting to a room in the North
West Lung Centre
Provide tea & coffee (possibly even sandwiches) from
1pm – there is a small socialising area

43. Format & content
Numbers attending smaller
Some comments that content is less relevant to all
and a return to talks on aspergillosis would be
welcome
Suggestions:
More involvement from centre staff
More, shorter sessions in specific areas every month

44. Format changes – 20 min sessions

45. Other suggestions
Doctor present for 20 min at every meeting
We have a session held by a patient – once per
month (volunteers?)
Your choice of subject
Patient leader(s)
Comment sheet to be available at each meeting for
anonymous constructive criticism

46. Thank You
“The best chance we have of beating this illness is to
work together”
Living with it, Working with it, Treating it
Fungal Research Trust